Insurance Billing for Massage Therapists

 Putting it all together.

So now with all this information how do you figure out what

to do in your state and how do you find out what insurance companies will pay you?

You will need to call prospective insurance companies to find out what you need to do.  You can usually get a list of them at your State Insurance Commissioners office (see appendix for list).  You can also wait and do this when a client calls asking to bill their insurance company.

How to get paid –Calling to Verify Benefits and Billing Procedures

Here is a checklist of questions you will need to ask each company:

·        Do you pay for massage therapy services?  Are massage therapy services covered by this client’s policy?

·        Do I need to be on a provider list?  If so what is the process for becoming a provider?

·        What CPT codes do you allow for massage therapy services?   (Some companies only allow certain codes to be billed by massage therapists.)  How many units of each code are allowed?  (4 units = 1 hour: can you bill for more than an hour? – usually not, but in some cases you can)  You can also tell them what code you bill and ask if they will allow this code and what is the allowable fee.

·        Can I bill multiple codes? What combination of codes can I bill?  Tell them what codes you use and find out if they will pay you for those codes.

·        What is the allowable fee per code?  This is the amount they will pay.

·        Do I need a prescription from the physician?  (If they say no, it is always a good idea to get one anyway.) If they say no, ask if a Diagnosis code (ICD-9) code is necessary.  If so, then point out that a prescription will be necessary, as you are not allowed to make a diagnosis.

·        Do I need a referral?  A referral may be different than a prescription. It may involve the physician initiating the referral to the insurance company and they send the referral to you.

·        Is there any restriction on the Diagnosis code?  Can you treat for all codes or will there be some that won’t be allowed? 

·        Do I need to send chart notes when submitting a bill? 

·        Do I need to send the prescription when submitting a bill?

·        What is the normal processing time for payments?

·        Where do I send the bill?  Do I need to send it to anyone’s attention?

·        Is there any statue of limitations on the time allowed to bill for services?  If there are any problems with the bill and it is rejected, how much time will you have to resubmit it.  Most companies allow 6 months to a year.  After that time, you will not be paid no matter what.  In some cases, it may take that amount of time to get the bill straightened out.

·        What are the policy limits and benefits?  Some policies have a dollar limit or number of treatment limit or a time limit like 3 years.

·        How much of the available funds/sessions have been used?  Has the client had previous treatment from another massage therapist that used some of the allowable benefits?

·        Is there a deductible?  Has it been met?

·        Is there a co-insurance or co-pay?

·        Do I need to submit a W-2 form?  This is often needed, as companies will supply you with a 1099 form for tax purposes.

The other things that can save you a lot of time are:

Have the client call and verify benefits using the form in the appendix. 

Send bills registered or certified mail to ensure their delivery.

Double check your billing forms to make sure it is filled out completely.  Make sure all information is correct.

Don’t work without a prescription.

It is often difficult to find the right person to talk to at an insurance company that will help you.  Most companies have a customer service representative for your area.  Keep asking if you are not getting your questions answered.  Other people that may be of help to you are the billing specialist (the person who actually keys the bill into the computer), the claims adjuster, the case manager, the lawyer or paralegal. 

My guess is that you will not be able to get all of your questions answered! The key to getting paid is to accept the fact that you will have problems getting paid and will have problems working with insurance companies!

[ Home ] [ Table of Contents ] [ Intro ] [ Cost Per Client ] [ Setting Your Fees ] [ Types of Insurance ] [ Personal Injury ] [ HMO's, PPO's ] [ How to become a p ] [ Contracts ] [ Injured Workers ] [ HCFA Intro ] [ Fill out HCFA ] [ CPT Codes ] [ The ICD-9's ] [ Documentation ] [ SOAP Charting for Massage Therap ] [ Reports ] [ Getting Paid ] [ Networking ] [ In Summary ] [ Issues and Ethics ] [ Glossary A-E ] [ GlossaryF-O ] [ Glossary P-Z ] [ Insurance Benefits Verification ] [ Track communications with the in ] [ Physicians Referral for Massage ] [ Progress Report From ] [ Resources ]

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